MAC COOPER

SALMON, ID
NPI1831627710
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy208100000X Physical Medicine & Rehabilitation
(Licence: ID  PTA5126)
Enumeration Date2017-05-23
Last Update Date2017-05-23
Business Address
MAC COOPER PTA
802 SHOUP ST
SALMON, ID 83467-4305
Phone number: 208-756-2005
Mailing Address
MAC COOPER PTA
PO BOX 1107
SALMON, ID 83467-1107
Phone number: 208-756-2005